Not Everyone Needs a Deep Teeth Cleaning
Don't Be This Guy

I was talking to this guy, we will call him Rich, and during conversation I revealed I was a dental hygienist. This always makes things interesting; either people immediately stop smiling or go on to share a couple dental experiences, traumas or problems. Rich went on to state that it was time for a"deep cleaning", it had been a while. Since that statement struck me as odd, I asked what he meant, how did he know.

Periodontal disease is defined as a chronic bacterial infection that results in the loss of connective tissue and bone, depleting attachment to the tooth.

According to, "Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed".

It's this loss of attachment and inflammation of the gums that help dictate a need for deep cleanings. Nothing else. If you don't have pockets, gum infections or periodontal problems, then there is nothing to deep clean.

He went on to say, that a few years back, he hadn't used up any of his dental insurance and that the dentist thought it was a good idea to get a "deep cleaning". I asked him if he had a history of gum infections or periodontal disease and he said no.

A typical deep cleaning aka scaling and root planning aka quadrant therapy aka non-surgical periodontal therapy procedure is indicated when a patient presents with gingivitis, deep pocket depths exceeding 4-5mm, neglected hygiene, and, sub and supragingival bacterial deposits. Multiple appointments are usually needed accompanied with the use of local anesthetic for comfort.

Any area with pocket depths of 5mm and higher cannot be accessed with a toothbrush or floss. As a result, deep cleanings are done to remove plaque, tartar and bacteria from the pocket where the patient can't get. This helps arrest the progression of the disease. When the deposits are removed and the tooth structure is clean it promotes tissue reattachment and reduces the inflammation. This allows the patient a better chance at keeping the disease at bay. Periodontal disease is not curable, just maintainable. If it goes untreated, the patient risks loosing their teeth and other complications.

Anyway, as his story continued and not to my surprise, after enduring needless treatment the insurance denied his claim. Apparently there was no evidence of a need for the "deep cleaning" and paid about $1000.00 out of pocket. Hopefully after my explanation he realized that a "deep cleaning" is a specific procedure to help people with periodontal problems, not just a really thorough cleaning.

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